NEW DELHI: An expert committee set up by the Supreme Court has laid down minimum standards for intensive care units (ICU), defining what a hospital must have in place to have an ICU, including infrastructure, equipment and staffing. The framework provides for dedicated ICU space to provide emergency services, operating rooms and laboratories, as well as backup power, sanitation and appropriate layout. Bedside essentials include oxygen, suction and electrical points, as well as equipment such as monitors, ventilators, defibrillators, emergency carts, infusion and syringe pumps, blood glucose meters and electrocardiographs.
List of new rules
Staffing is at the heart of the norm. ICUs must be led by trained doctors and staffed around the clock, have higher nurse-to-patient ratios than wards – from 1:2 to 1:3, and up to 1:1 for critically ill or ventilated patients – and be supported by allied health staff. The guidelines also emphasize that continuous monitoring, life support systems, and strict infection control protocols are critical for ICU care. The code is part of the Guidelines for the Organization and Delivery of Intensive Care Services, a report drafted by a three-member committee, reviewed by medical experts and endorsed by the courts as “practical, implementable and necessary as minimum standards for intensive care units”. A bench of Justices Ahsanuddin Amanullah and R Mahadevan has asked states and union territories to submit action plans by May 18 to identify gaps and implementation strategies. The Supreme Court-appointed panel, comprising AIIMS doctor Nitish Naik, Solicitor General Aishwarya Bhati and advocate Karan Bharioke, said clinical judgment should guide the decision on the level of care required. Dr. Harsh Mahajan, chairman of Mahajan Imaging Laboratory and one of the experts who reviewed the guidelines, said the guidelines recognize the disparity in rural and remote areas and recommend measures such as temporary staffing norms and linking small ICUs with senior centers through e-ICU or tele-ICU support. Dr Saumitra Rawat of Sir Gangaram Hospital, who was part of the review panel for the guidelines, said: “The new guidelines have divided ICUs into different levels and even entry-level units have to meet the prescribed standards.”
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